Clinical experience with ferric carboxymaltose in the treatment of cancer- and chemotherapy-associated anaemia

Abstract

Background: Intravenous (i.v.) iron can improve anaemia of chronic disease and response to erythropoiesis-stimulating agents (ESAs), but data on its use in practice and without ESAs are limited. This study evaluated effectiveness and tolerability of ferric carboxymaltose (FCM) in routine treatment of anaemic cancer patients.

Patients and methods: Of 639 patients enrolled in 68 haematology/oncology practices in Germany, 619 received FCM at the oncologist's discretion, 420 had eligible baseline haemoglobin (Hb) measurements, and 364 at least one follow-up Hb measurement. Data of transfused patients were censored from analysis before transfusion.

Results: The median total iron dose was 1000 mg per patient (interquartile range 600-1500 mg). The median Hb increase was comparable in patients receiving FCM alone (1.4 g/dl [0.2-2.3 g/dl; N = 233]) or FCM + ESA (1.6 g/dl [0.7-2.4 g/dl; N = 46]). Patients with baseline Hb up to 11.0 g/dl and serum ferritin up to 500 ng/ml benefited from FCM treatment (stable Hb ≥ 11.0 g/dl). Also patients with ferritin >500 ng/ml but low transferrin saturation benefited from FCM treatment. FCM was well tolerated, 2.3% of patients reported putative drug-related adverse events.

Conclusions: The substantial Hb increase and stabilisation at 11-12 g/dl in FCM-treated patients suggest a role for i.v. iron alone in anaemia correction in cancer patients.

Figure 1

Median Hb levels over the course of the study period and stratified by different patient characteristics. *Data were censored for transfusion use. (A) Median Hb stratified by concurrent ESA use and censorship of data following a blood transfusion. (B) Median Hb levels stratified by baseline Hb. (C) Median Hb levels stratified by baseline serum ferritin (cut-offs <30 and ≥100 ng/ml according to thresholds for absolute and functional iron deficiency by NCCN [11]). Hb, haemoglobin; BL, baseline; EOS, end of the study (weeks 12–14); ESA, erythropoiesis-stimulating agent.